Impact of immunosuppression minimization and withdrawal in long-term hepatitis C virus liver transplant recipients

4^th Global Surgery and Transplantation Congress

October 03-04, 2016 Atlanta, USA

Giuseppe Tisone

University of Tor Vergata, Italy

Posters & Accepted Abstracts: J Transplant Technol Res

Abstract :

HCV-related disease is the most common indication for liver transplantation (LT). HCV recurrence, which is almost universal, has a significant impact on patient and graft survival after LT and still represents a great unsolved issue for the liver transplant community. Since Interferon and Ribavirin have limited efficacy and can be administrated only in selected transplant recipients and considering the lack of long-term results of the new direct acting antiviral agents on HCV-LT recipients, the achievement of immunosuppression minimization and when possible, the immunosuppression-free state, still play a central role in the avoidance of rapid HCV recurrence. On this regard, the antimetabolite use (namely Micophenolate) in the mid-term LT recipients seems to favorably impact the natural history of HCV recurrence. It is likely that the avoidance of IS in LT recipients should be the main purpose in order to restore the immunity and contrast the HCV disease. Literature reports 21 cases of HCV-LT recipients who successfully achieve a sustainable IS-free state but in most of them the long-term histological finding was not reported. Only our group published a long-term HCVtransplanted series on more than 300 yearly consecutive liver biopsies in which a lower fibrosis progression rate was showed in those recipients who were off any immunosuppressant agents. In conclusion, the long term LT recipients should always be considered for withdrawal. In those who require immunosuppression, the use of anti-metabolites should be considered in spite of calcineurin inhibitors.

Biography :

Email: tisone@med.uniroma2.it